JRSM > Volume 98, Number 6 > Pp. 292-293

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Letters

Cardiac revascularization

Romeo J Vecht

118 Maida Vale, London W9 1PT, UK

E-mail: r.vecht{at}virgin.net

Lindsay John needs to be congratulated for his rational, balanced review of revascularization techniques (January 2005 JRSM¹). Twenty years ago all coronary patients were referred to the surgeons. Today most undergo angioplasty and stenting, despite recognition that surgical results are generally superior and probably not now much more costly. Furthermore, the surgical approach is more comprehensive, requires less reinvestigation and is more globally acceptable. In opposition, interventional cardiologists have accepted a constant restenosis rate, an occasional irretrievable balloon and more recently stent thrombosis reports.² Ongoing haemorrhagic risks associated with antiplatelet agents cannot be ignored and repeated radiation exposure is hazardous to both patients and operators.

There are other considerations: what is the long term effect of metallic intrusions inside arteries? What happens when the eluting substances become depleted? As Lindsay John correctly remarks, when those stented patients eventually reach the surgeons, suitable sitings for bypass conduits can become problematic.

David Taggart in a recent article favours surgery over percutaneous interventions for severe coronary artery disease.³ I believe he is right. At best angioplasty is a time-buying operation with limited benefits. It might be more profitable for our patients if interventional cardiologists instead of becoming robotic technocrats returned to basic, unbiased clinical assessment and management and provided more supportive efforts in the aftercare of patients requiring coronary surgery. They need to candidly consider the benefits to the patients rather than apply their skills to achieve the often unachievable. The pendulum it seems has swung from one extreme to the other. It is high time to adopt a median standpoint.

REFERENCES

1. John LCH. Cardiac revascularization—a need for independent decision makers. J R Soc Med2005; 98:1[Free Full Text]

2. McFadden EP, Stabile E, Regan E, et al. Late thrombosis in drug eluting coronary stents after discontinuation of anti-platelet therapy. Lancet2004; 364:1519 -21[CrossRef][Medline]

3. Taggart DP. Surgery is the best intervention for severe coronary artery disease. BMJ2005; 330:785 -6[Free Full Text]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vecht, R. J Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?